Title

PUNCTATE INNER CHOROIDOPATHY – CASE REPORT

Introduction

Punctate inner choroidopathy(PIC) is a bilateral ocular inflammatory disease that mostly affects young, healthy and myopic women. Although the etiology has remained uncler, PIC was proposed to be a variant of multifocal choroiditis. Little anterior segment or vitreous inflammation occurs. Bilateral white-yellow chorioretinal lesions develop at the level of the inner choroid and retinal pigment epithelium(RPE), and rarely extend to the midperiphery. They are usually bilateral, tough asymmetric. They progress to atrophic scars and appear punched-out. Choroidal neovascularization(CNV) can occur as a frequent complication of this condition. Diagnosis is based on typical ocular findings;laboratory evaluation is usually not helpful.

Methods

Medical record review.

Results

A 59-year-old-woman was referred to our service due to changes in the fundoscopy of her both eyes, with no visual complaints. On ophthalmological examination, best corrected visual acuity was 20/30 in both eyes and no remarkable findings in the slit lamp. Fundoscopy of her both eyes showed normal optic disc, perifoveal atrophy and scattered punched-out lesions throughout the posterior pole. Spectral domain OCT revealed fragmentation of the external plexiform layer and areas of retinal thinning. FA showed hyperfluorescence due to window defects, compatible with areas of atrophy of the RPE caused by the chorioretinal lesions. Hyperautofluorescence in areas of fresh lesions and hypoautofluorescent spots corresponding areas of chorioretinal atrophy. As this patient’s ophthalmologic findings were chronic, a six-monthly follow-up was carried out to evaluate the evolution, since the patient did not present signs of complications.

Discussion

No treatment is advised for PIC. Visual prognosis is generally good, and depends on the status of the macula. In acute cases, treatment is aimed at inflammation and its sequelae. Therapy includes topical, periocular, intraocular or systemic corticosteroids; anti-VEGF and immunosuppression, in select cases.

Keywords

punctate inner choroidopathy, CNV, complementary exams, fundoscopy, OCT, angiofluoresceinography, autofluor

Area

CLINICAL CASE

Authors

Walther de Oliveira Campos Neto, Paulo Henrique Horizonte, Carolina Maria Barbosa Lemos, Fernanda Salata Antunes, Raimunda Cristina Mendonça Freire de Oliveira, Andréia Novelli, Guilherme Daher G. M. Reis, André Marcelo Vieira Gomes